Although I’ve spent my entire nursing career (over 20 years) as a Medical-Surgical staff nurse, I spend the overwhelming majority of my work hours in academia, teaching in and/or directing nursing programs. Because of this, during COVID-19, I worked fairly minimally in the hospital and started to feel disconnected from the challenges staff nurses of today are experiencing. I would see staff nurses protesting working conditions on the news, but I felt as if I did not have my usual strong sense of what was actually happening on the nursing units.
That shifted a couple of months ago when I returned to work a few 12-hour night shifts as a staff nurse. During one of the shifts, we were not able to take any breaks. Instead, we needed to jump up from meals at the nursing desk to answer call lights. The unit I floated to on that shift—a high acuity telemetry/dialysis unit—included profoundly sick patients that, during my shift, had no nursing assistance support. One of my patients had a potassium level well under three, which the prior shift had been working for many hours to remedy without success. Several other patients were very high fall risk. One of the other nurses on my shift had three patients on contact precautions. I do not have a telemetry/cardiac nurse background, so I knew I would need to lean on the expertise of the cardiac nurses, but also was acutely aware that they too were stretched to their limit with a crushing workload. Due to the low staffing levels, we spent large chunks of our limited time performing procedures usually done by nursing assistants, such as taking vital signs and tending to many other basic needs of the severely ill patients.
Given the staffing levels, I found myself at times making very difficult decisions about what tasks I should prioritize to complete on time versus what important items I would need to defer to a later time. Being in this position was distressing in a variety of ways. As nurses, we understand that patients might not have the clinical outcome we had hoped for, but it has always helped me sleep easier knowing that I treated the patient based on the standards of care. So long as I am able to serve the patient with the standard of care, I feel comfortable that I’ve done my part. This recent work showed me that many of us who work in the inpatient acute care setting right now are inevitably experiencing the distress of not being able to serve patients to the level that provides us comfort and well-being. We have a well-developed sense of things we should always be able to deliver to patients, and with COVID-19, that has not always been possible. I was just visiting, but I can imagine, day in day out, this takes a major toll on morale and enthusiasm.
I'm really appreciative of all those who find ways to tap into the motivations that prompted us to choose careers in nursing and connect us with the aspects of our roles that bring us joy. I am hopeful that the worst of the pandemic is behind us. My optimism about the future stems from my experience during the start of my career. I began my career in nursing in 1999, just as a national surplus of nurses was ending. This surplus led to low morale due to layoffs, poor compensation, and other hardships that accompanied the large supply of nurses. Stepping in at the tail end of that, things quickly transitioned into what would become a severe national shortage of nurses. When that shortage hit, I saw systems change; the contributions of nurses were increasingly valued and better compensated. Nurses’ insights and requests were heavily contemplated and followed up on. I feel that, in part due to the pandemic, there are many parallels in today’s nursing world from the time I entered this field because we are increasingly entering a nursing shortage, morale is low after years of COVID-related hardships, and the insights of nurses have not always been well matriculated into policy. While depressing in the moment, this provides a fertile ground for better times. For those of you feeling frustrated, I hope that you will join me in finding out what the nursing world of tomorrow looks like!
Daniel M. Doolan, PhD, RN, is a staff nurse and an Associate Nursing Professor at Samuel Merritt University in Oakland, California, USA. He is a member of Sigma’s Lambda Gamma Chapter and Nu Xi at-Large Chapter.